Expert: Rob Painter, Ase, CFEI, CAFATE - 5/14/2009

Question
My father was a pedestrian hit by a car in April 2009. He had no car insurance and neither did anyone in his household. The insurance company of the driver  states they had $10,000 pip and pays at 80% and $10,000 for pain and suffering. The total of the bills come to about $16,000 for one and about $13,000 for the other (he had a head injury). My father has medicare and medicaid for health insurance and The adjuster states he would have to send my father a check for pain and suffering with both his name and the hospital name on the check. Is this correct and why is it being done this way

Answer
Hello,

I am not an attorney, but have been involved in insurance claims issues and courts for years.

All I can think is that your father is not going to get anything and the money in the check will be applied to the medical bills and possibly be given back to Social Security because they are the ones that had to initially pay the meds.

Let's say there was insurance. You get injured. The settlement is $100,000. The attorney gets 33.3% off the top. $67,700 left over. Now, you had medical bills of $50,000 that you health insurance company paid. That $50,000 goes to your health insurance company. So for the $100,000 you see someone bragging about from a car accident, you are left with $17,700 out of the $100,000.

There are variables to this, but I just wanted to give you an example.

In your case, even if your dad gets a portion of that check, the other concern is that Social Security may look at it as additional income and $10,000 for a year will disqualify him from Social Security.

On the flip side though, he is basically unsuable for any additional medical billing because he is on Social Security.

This is a very bad deal for your dad and although it sounds like he was seriously injured, thank God he is at least alive.

I would suggest that your dad contact Social Security and ask how much he can recieve without it affecting his benefits.

Then have hime contact the hospital and see if he can negotiate the amount he can keep. Lawyers get substantial discounts negotiating medical bills. Remember, if he doesn't sign the check, they get nothing and if he does at least they get something.

I hope my answer assisted you and your dad. If so, please rate my answer.

Good Luck!

Rob